Does patient and public involvement impact public health decision-making? A 10-year retrospective analysis of public consultation in Brazil

Abstract Background: The aim of this work is to characterize the processes associated with patient and public involvement (PPI) in the form of public consultations (PC) during the first 10 years of operation of the National Committee for Health Technology Incorporation in the Unified Health System (Conitec) of Brazil and to identify factors associated with changes in Conitec’s recommendations following these PC. Methods: This cross-sectional study analysed all processes related to the adoption of technology that took place in Brazil between 2012 and 2021 based on technical reports and self-reported information collected from PC participants. A multiple logistic regression model identified factors associated with changes in Conitec’s recommendations following PC. Results: A total of 479 technical reports were published, of which 83% (n=400) were submitted to PC. Demands were made mainly by applicants from the state (n=262; 55%), regarding the adoption of medicines (n=367; 77%), in which context neoplasms and infectious diseases were the most frequent indications (n=66; 14% for each). A total of 264 (55%) processes resulted in a final recommendation in favour of introducing the technology. Over the period of 10 years, 196,483 contributions were received in response to PC. The largest volume of contributions was made by patients and their families or representatives (n=99,082; 50.4%), females (122,895; 67%), white individuals (129,165; 70.8%) and individuals between the ages of 25 and 59 years (145,364; 79.9%). Alteration of the preliminary recommendation occurred in 13% (n=53) of the PC, with a higher proportion of recommendations being altered from 2017 onwards. Increased participation by patients had a significant impact on the alteration of the preliminary recommendation (Odds Ratio 3.87, 95% CI 1.33-13.35, p=0.02). Conclusions: It is necessary to develop PPI mechanisms that are more dialogical and less vulnerable to political contexts with the aim of establishing a more equitable and accountable health system.